James Koehler, MD - Cosmetic Surgeon in Fairhope, Alabama

The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life-changing decision, and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There's no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie, and you're listening to Meet the Doctor. Welcome back to Meet the Doctor. My name's Eva Sheie, and my guest this morning is Dr. James Koehler. He's a cosmetic surgeon practicing in Fairhope, Alabama. So my first question is, where is Fairhope, Alabama?

Well, it's right near the beach, right near the Gulf Coast, so a lot of people don't even know that Alabama has a coastal region right along the Gulf, and Fairhope is probably 45 minute drive north of the Gulf Coast, and it's right across the bay from Mobile, Alabama.

Can you see water from your office?

No. You can't see the water, but it's pretty close. It's

Like you can smell it?

Almost. Yes.

How did you come to be in Fairhope, Alabama? That's not like a destination where doctors say, I'm going to set up shop in.

Yeah, well, I mean there's a longer story, but I did my medical school and residency at University of Alabama in Birmingham. So my wife's family is all here. My family's all here in Alabama, so we did have ties here, but not in Fairhope and when was in Oklahoma practicing and finally made a decision that I wanted to do my own thing. Opportunity came available in Fairhope and this practice became available and it was something that I could walk into and take over and brought us closer to family and then also the beach. So it was a pretty attractive move for us.

I've known you, I was trying to figure out how long, and it's 2023.

Almost 20 years?

Yeah, it's definitely over 15 years.

Yeah, it's over 15 years, I'd say. Yeah, at least 15 years.

Going from where you were in Oklahoma to Fairhope. Now looking back on it, it just sounds like it was this fun, easy thing that you did, but it was actually a pretty big risk, wasn't it?

Yeah, I mean, it was hard because I'd been in Oklahoma for 10 years and you build up reputation in an area. You've got patients that are referring their friends and to get up and move to a completely different geographic location that's not even close. It's starting over. Fortunately with the internet, it's not completely starting over. I mean, you've got an online reputation and all that sort of thing, so you kind of bring some of that with you. But yeah, it was taking over a practice and the surgeon that I was taking the practice from, he got injured and he was disabled. And so there was a period of time where he was trying to keep the practice up and going, but he wasn't doing surgery. And the longer that continued, the more the word on the street was, oh, that practice is closed. And so anyhow,

Sharks in the water.

Yeah. It was just kind of like it took a little while to get things to take off. And so it wasn't an easy go, but definitely been rewarding in the long run. So

Now, did you inherit a team when you took the practice over and are some of those people still there with you?

Yeah, I inherited a team of people and actually a lot of 'em are still here, and it's been a ride and they've been a part of that. So it's been fun.

It's exciting. It's nice for your patients too that there's some continuity from before and after too, and I suspect that they have their own relationships with people.

Oh, yeah. So Dr. Staggers, who's the plastic surgeon, I got the practice from his patient coordinator, Denvia, she had been with him since, I guess probably about 2002 maybe. So 2001, and she's still here with the practice. And so I'm operating on some of the patients that he operated on 15 years ago, and they come in the office and they're like, oh, Denvia she's still here. And so yeah, that familiarity has been nice. And yeah, I mean for her it's, it was a bit of a, not a difficult transition, but it's a new doctor, but fortunately he and I have a lot of the same philosophies on how to treat patients. And so it's been actually a really, I think a good transition.

So does Denvia feel like family member now?

Oh yeah. She's like my sister.

Yeah. That's awesome. Being an early adopter is not something that everyone is comfortable doing, but sometimes we're forced to be. And I was thinking about you this morning because I was remembering how I told you you needed to get on Facebook and start talking to patients there, and I had to actually convince you is the way I remember it. I promise it's going to work and you have to trust me. And I wonder if you remember that the same way I do.

Oh, yeah, absolutely. That was actually probably around 2008 when things kind of got a little bit slow from an economy standpoint and from a marketing perspective, I mean, I was trying to figure out ways that I could grow my practice that weren't going to be super expensive. And anyhow, I turned to Facebook and I definitely was an early adopter when it came to social media. I mean, I look back on it now, I'm like, nobody was doing it. And I just invited my existing patients to join me on Facebook. And then we started chatting and started sharing stuff and almost got banned from Facebook a few times for putting up some pictures. And I mean, I look back now, I'm like, man, that picture was now, you'd see that all over social media, but back then, I mean, it was like, oh, what? You can't put that up there. I mean, it wasn't even nudity. But anyhow, yeah, I remember it was a good thing. It definitely grew some awareness of where I was and what we were about, and it was fun.

Do you think you're the kind of person who is unafraid to try new things? Is that generally how you operate?

Yeah, I'm definitely, I don't know. I would say I'm an early adopter on a lot of things, but sometimes, depending on the situation, I might hold off a little bit, but I'm certainly not one to wait to the bitter end, but I'm always up for trying new things if they make sense.

So when you opened your doors in Alabama, do you remember feeling like the patients there or the community there was different in any way from where you had been in Oklahoma?

Yes, but looking back on it now, I can't even describe why I had a little bit of that feeling. And maybe it's just because when you have an existing patient base, even though you're seeing new patients, you've got familiar faces that run through your practice, and when every patient that you meet is a new person that you've never met before, I mean, I don't know, maybe that was part of why it felt a little different. But yeah, I do remember just feeling like it's different doesn't now, but it did right at first.

So when someone comes to see you for a consult, what kind of experience can they expect from that first meeting with you?

Well, I would say that first of all, they're going to spend a fair bit of time with one of my patient coordinators, and they're going to get all the background information. So we really like to make sure that they have a clear understanding of what the whole process is. And then when they get to see me and I've had a chance to examine them, I think the one thing that, I mean, I try to still live by this today is when I'm offering treatment plans to patients, I really want to try to offer them, if this was my family member, what would I want to do? And I feel like if I do that every single day and just try to treat people, I would want my family members treated, then we're going to be in good shape. So I mean, we just give them an honest opinion of what I think they can expect and what they can achieve, and we try to build the expectations correctly, I think with social media and just so much information that's out there.

(09:07)
And of course every doctor wants to present their best work, and we all do. We're proud of the good work we do, but not everything's a home run, and not every patient that comes in has the body shape or body type or face type that's going to allow you to get that kind of home run result. And so I try to make sure that we don't want to make it sound like, oh, you might not get what you want, but we got to be real. I think we can make big improvements. We just might not get that picture that you're showing me on Instagram. That's not going to happen. So we try to just get them information, give them a good detailed treatment plan that they can think about and build the expectations to where we can get them. That's kind of what it's about in the consultation.

I read through dozens and dozens of reviews about you and your team, and in fact, you have over 1100 reviews on just real patient ratings, which is to me one of the most trustworthy places to read reviews because I know it's coming from surveys and that those surveys go to literally every single one of your patients.

Yeah. Well, actually one of the prouder moments I guess, that we had after I bought this practice, and I'd been here for several years, they had this global aesthetics awards thing that I've never even really heard about, to be honest with you. But I got this email saying, Hey, you've been nominated for this Global Aesthetics award for, it was like a, I can't remember what it was, patient satisfaction or patient, something to do with patient satisfaction. And it was based off of our real patient ratings reviews, and there were, I think eight doctors throughout the country that got nominated, and it was based off of these patients surveys. And anyhow, I didn't win it, but I was in the top eight in the country for that, and I thought that was pretty cool. So

That is remarkable. In fact, when you anonymously survey and as a business owner, this is a really hard thing to do, is to say to the people who you see every day, I want you to give me feedback, but I don't want to know who you are. I can't even fix it if you're anonymous. It takes a lot to do that and to put yourself in the position where you are asking for that kind of feedback and reading through them all, there were some things that stood out to me and the words, these words came back over and over and over, helpful, positive, friendly, and listened. Also, transparency, I saw quite a few times in there, and I wonder if you are intentional about doing those things or if that's just kind of how you are all functioning as a team right now? Is that the way that you just are as people?

Well, I think a lot of the credit has to go to, yes, my staff, I love my team. I think we all have kind of agreed on what our philosophy as a group is and what we want to achieve, and everybody is bought into that. So it's not forced. It's something that really kind of comes naturally to everybody that works with me, but we know we want to treat people the way we want to be treated. And it's a very simple philosophy, and I think the fact that we really enjoy what we do just comes across. One of the things in my clinic, my staff are always laugh, not laughing, but we laugh, we have a good time. I think it just comes across to the patients. We enjoy what we're doing. And so again, I don't think it's anything forced, it's just the people.

I'm curious if people have started to pick up on that from outside of the area, the local area that you're in there. Are you seeing patients come from all over the place?

Yeah, we do. And some people from quite a ways away. I often wonder how they hear about us, but we've had people from New York and LA and other parts of the country, a lot of, we do draw regionally here from people in the southeast, so we get people from Florida and Mississippi and Louisiana, but sometimes we get people from a great distance and sometimes it's, oh, I have a family member here or something. They live in LA but their parents live here or something like that. So we have had the opportunity to reach out a little more than our just local geographic area. And it's a good bad thing. I certainly love treating people from wherever they come from, but when people are long distance away, it sometimes can be a challenge depending on what we're doing, managing things after surgery,

If we do travel there, is it comfortable? Is there a nice place to stay? How do you take care of people who are on the road for surgery?

Oh, well, there's plenty of hotels around here, and it's nice. I mean, actually, like I said, you're actually close to the beach. So if a person really wanted to kind of go, okay, hey, I want to go there. I'm going to spend a week, 10 days and just recover. You could get a place right on the beach and hang out there, but there's some really nice hotels in the area and it's easy to get to, not a difficult place to get to.

I want to hear more about your training, and I know that your path has been a little bit different than there's many paths to get to being a great aesthetic surgeon, but I'm interested in yours in particular, and if you'll tell us kind of how you got here down that training road.

Yeah. Well, my path is definitely different. I've actually had people over the years say, well, if you could do it over again, would you have done it differently? Would you have taken a different, more direct path? I'm like, actually, no, I don't think would've, A lot of the things that I did along the way just made me the person that I am, so I really don't think I would change anything. But originally I went to dental school. I thought I was going to be a dentist, and that really didn't happen. I ended up going from dental school and I did maxillofacial surgery and did medical school at the University of Alabama in Birmingham. And then after I completed my maxillofacial training, I did a fellowship in facial cosmetic surgery, and that was at University of Alabama in Birmingham. And then I stayed on faculty at U A B, and it was really at that point that I realized that I enjoyed doing the facial stuff, but also enjoyed the body work.

(15:57)
And so I went to Oklahoma and did a fellowship in full body cosmetic surgery. And after that I stayed in Oklahoma and practiced, and I was there for 10 years just doing general full body cosmetic surgery. And that's all that I do. I don't do, back in my training when I was faculty, I did a lot of trauma, a lot of facial trauma. In fact, more than I care to remember, I was doing two weeks a month at a level one trauma center of facial trauma and got more than my fair share of it. But now I still take call at my local hospital, but it's not a level one trauma center, so it's not like what I used to do.

What kinds of things do you see there?

At my local hospital? Oh, dog bites, people falling out a, you know at a nursing home, fall out of a bed and get a laceration or something like that. It's mostly little cuts and things. We're not getting gunshot wounds to the face and massive motor vehicle collisions. I mean, that stuff is going to the big center. So

Do you still do any face surgery? Like cosmetic face?

Oh yeah. Oh, I do. In fact, I love doing facelifts. I actually have been for the past, what, probably 10 years faculty for a course in St. Louis at St. Louis University, practical Anatomy with Mike Nyak. He hosts a course. It's an advanced facial rejuvenation course. And yeah, I've been fortunate enough to be faculty for that for the past 10 years. So yeah, I love doing facial stuff. It's not that I ever didn't like the facial stuff, just I wanted to, I like the variety and I enjoy doing a little bit of everything, all things aesthetic.

I feel like if you, in your training, learned how to take someone's face apart and put it back after an accident, that a facelift is probably within your skillset at that point.

Oh, yeah. Well, yeah. Some of the messes that we would see with the trauma, I mean, yeah, it's really kind of what got my interest in the cosmetic part, because you'd have these people that were, some of the injuries were more minor, but it's a broken nose, it's whatever. And then you come and see them postoperatively after they've healed and they're like, yeah, my nose is better, but it's not the same. I got this little bump or I've got this, or some of that stuff was preexisting, but now they're more aware of it since they had an accident. And so they're like, can you fix my nose and make it look pretty or whatever. And so that's sort of where a lot of this comes from doing revision trauma work, which is more aesthetic in nature. It wasn't just about restoring the function and making them look normal. It was sometimes enhancing things and trying to even improve upon it. So yeah.

I had a friend once who was, this is dumb stuff we did in our twenties. She was sitting on her husband's shoulders, and this was two in the morning in the middle of nowhere too. We were at the river or something, and she fell off and landed on her face on the deck and broke her nose, and the first thing she said was, oh, good, I get to get a run of plastic now.

There you go. There's your excuse.

I never forgot that. There's people out there just waiting for,

Well, it's kind of funny. I still see some patients that they're, oh, when I was five, I fell. That's why I have this bump on my nose. And it's almost like they're trying to give themselves justification for, they're giving themselves permission to fix this thing that they don't like. And I'm like, you don't have to explain that to me. You don't have to tell me you fell. That's fine. If you want to fix that bump, we can fix it. It doesn't matter.

Yeah, that's an interesting point because there's that cosmetic justification. Am I being selfish by wanting to change something about myself, whether it's your nose or something else, but then also feeling okay about spending that amount of money on yourself.

Yeah. I think where I probably see that fairly frequently is young mothers after having kids, and I just had a lady a week or two ago who's like, her kids were all stressed out, young kids were stressed out that she was having surgery, and then that whole like, ah, am I being selfish? I got to worry about my kids and I'm spending this money on myself instead of my family or whatever. And it was, I said, listen, I've been down this road plenty of times, and I get it. There's a guilty feeling that comes along with that. But at the same time, when it's all said and done and after they've done it, they're so grateful that they did it and they want to do something for themselves. They're giving, giving, giving, giving. And sometimes it's okay to say, you know what? There's got to be something for me and do it for yourself.

I wonder if we would feel as guilty if it was getting your teeth fixed or losing weight, because there's lots of physical transformations that we go through that are, I think, kind of in the same category, and that includes having surgery.

Oh, yeah. Well, I always joke around with people, I'm like, you know what? Nowadays, every kid gets braces. I mean, they all get braces. Now we know that they're all able to chew. Okay, so don't tell me that they're getting braces because they can't chew food properly. I mean, they're doing just fine, but every parent gets their kid braces because they want 'em to have straight teeth, and it's an appearance thing. They want to have nice straight teeth. So I mean, we can say, oh, functionally, oh, their teeth don't come together, but I promise you they're getting that food in there. There's a few rare circumstances where maybe that doesn't happen, but it's just what it is.

I think you and I are probably about of the age where braces were still really optional, and the kids who got them were either, their teeth were so disastrous that they had no choice, but there were lots of us who were just sort of like, it's pretty good, so we're going to leave it alone. That would never happen today.

Well, no, I mean, it's cool to have braces. The kids all want to have the colored,

It is?

Well, I don't know. They all enjoy getting those colored elastic bands and whatnot. So I would say, I dunno if it's cool, but it's certainly not uncool.

Yeah, I think if everyone's doing it, it just is. But my sister had headgear and boy, I tortured her. She looked so ridiculous.

Yeah.

Yeah. That's funny. Speaking of sisters, well, or of kids, really, tell us about your family a little bit.

So I just had my 23rd wedding anniversary. So I've been married for 23 years and I've got three kids. Two of them are in college, in fact, they're both graduating this year. My oldest is 22 and he's graduating from U A B, my alma mater. He's got an honors degree in biology, and then I think he's thinking of doing physical therapy. And then my daughter, she's 21, she's at Liberty University, and she's doing a degree in business and she wants to do nonprofit work. That's kind of her passion. And then I've got my youngest, my caboose, he's 15 and he just started high school, so two graduating college, one starting high school.

How did they feel about moving to Alabama when you guys left Oklahoma?

Oh yeah. I'll never forget the youngest one. He didn't know what was going on, but he was too young. But the older two, I remember sitting them down on the couch and telling him that we're moving to Alabama, and yeah, it was tough for them. That's a tough age. I'm thinking it was 10 years ago, so they were like 12, 11 years old. I dunno that there's a really good time. I think it was better than them being in high school. I think it would've been a lot harder if they were in high school doing that. But anyhow, yeah, it was a difficult move, but kids are pretty resilient. It doesn't take them too long and they find new friends and they're back at it.

What do you like to do outside the office? I know you already, you told me that you work a ton and there's not a lot of free time.

So I try to work out, I go to the gym three days a week, so that's part of my evening activities on Monday, Wednesday, Friday, I try to hit the gym after work. When I first got the practice going, I didn't even have time to even think about working out. It was just a lot of stuff going on. And yeah, you realize at some point you got to take time for yourself for your own mental health. And going to the gym for me has been awesome. I mean, I enjoy it. I get to blow off some steam and I feel good at the end of it. So I do enjoy doing that. Other than that, I mean, my youngest son plays lacrosse. Actually, both of my boys played lacrosse, but my youngest is the one that's playing right now. And so, well, we haven't started fall lacrosse yet, but anyhow, he travels because we just don't have a lot of teams locally. So every weekend we're going somewhere for lacrosse. So it's Mississippi, Louisiana, Florida, going somewhere to.

Tell his coaches if they want a spring break trip to Austin, we'll hook it up. You got 'em.

I'll let 'em know for sure.

We can get them all the games in Austin.

Yeah, he just went to the Navy lacrosse camp, which he enjoyed that a lot. I mean, he got to stay. That was cool. Stay in the dorm and then it was like a three, four day camp, so it was exciting. My oldest son, he went to the Duke lacrosse camp, so I dunno, they both got to go to places where lacrosse is pretty important part of the programs there. So

Yeah, best game on Earth, won't get any arguing from me on that.

It's fun.

If someone's listening today and they want to come see you, where's the best place to learn more about your practice?

Well, I mean, obviously you can go to our website, which you can see a lot of examples of my work there before and after pictures. But there's information about any procedures as well. So website's always a good place. So it's eastern shore cosmetic surgery.com. You can go to our social media on Instagram or Facebook. I mean you can call the office (251) 929-7850 and you can speak to our front desk people and they can certainly, if you're interested in, they can set you up with our patient coordinators.

And you're about to start a podcast of your own.

Yes, about to start my own podcast.

It does not have a name yet, but when it does, we'll add it to the show notes for this episode and make it easy to find.

I think I might have to do, I might do a social media poll, a contest.

Oh yeah.

That might work.

Ooh, I like this. We'll put the title options up and see what the audience thinks.

Sounds good.

Thank you, Dr. Koehler.

Alright, thank you.

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